Thirteen-Valent pneumococcal conjugate vaccine in children with acute lymphoblastic leukemia: Protective immunity can be achieved on completion of treatment

Jessica Bate, Raymond Borrow, Julia Chisholm, Stuart C. Clarke, Elizabeth Dixon, Saul N. Faust, Angeliki Galanopoulou, David Goldblatt, Paul T. Heath, Tom Maishman, Susan Mapstone, Soonie R. Patel, Antony P. Williams, Juliet C. Gray*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background. Children with acute lymphoblastic leukemia (ALL) are at increased risk of developing invasive pneumococcal disease. This study describes the immunogenicity of 13-valent pneumococcal conjugate vaccine (PCV13) during and after chemotherapy. Methods. Children with ALL were allocated to study groups and received a single dose of PCV13: group 1, maintenance chemotherapy; group 2, end of chemotherapy; group 3, 6 months after chemotherapy. A protective vaccine response was defined as at least 10 of 12 serotypes (or >83% of serotypes with data) achieving postvaccination serotype-specific immunoglobulin G ≥0.35 µg/ mL and ≥4-fold rise, compared to prevaccination at 1 and 12 months. Results. One hundred eighteen children were recruited. Only 12.8% (5/39; 95% confidence interval [CI], 4.3%-27.4%) of patients vaccinated during maintenance (group 1) achieved a protective response at 1 month postvaccination and none had a protective response at 12 months. For group 2 patients, 59.5% (22/37; 95% CI, 42.1%-75.3%) achieved a response at 1 month and 37.9% (11/29; 95% CI, 20.7%-57.7%) maintained immunity at 12 months. For group 3 patients, 56.8% (21/37; 95% CI, 39.5%-72.9%) achieved a protective response at 1 month and 43.3% (13/30; 95% CI, 25.5%-62.6%) maintained immunity at 12 months. Conclusions. This study demonstrated that the earliest time point at which protective immunity can be achieved in children with ALL is on completion of chemotherapy. This is earlier than current recommendations and may improve protection during a period when children are most susceptible to infection.

Original languageEnglish
Pages (from-to)1271-1280
Number of pages10
JournalClinical Infectious Diseases
Volume71
Issue number5
DOIs
Publication statusPublished - 1 Sept 2020

Bibliographical note

Funding Information:
This trial is primarily funded by the Research for Patient Benefit program of the National Institute for Health Research, with additional financial support from Pfizer (formerly Wyeth).

Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

Keywords

  • Acute lymphoblastic leukemia
  • Immunization
  • Immunocompromised
  • Pneumococcal conjugate vaccine

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